1291. Hepatitis C Clinic at a Comprehensive Cancer Center: The successful story of multidisciplinary efforts
Session: Poster Abstract Session: Viral Epidemiology
Saturday, October 22, 2011
Room: Poster Hall B1
Background: There is no evidence-based information about management of cancer pts with hepatitis C virus (HCV) infection. Unfortunately, studies that address HCV therapy exclude pts with cancer, in part because baseline hematologic abnormalities can be exacerbated by HCV therapy. We report the experience with the HCV clinic in our cancer center. 

Methods: In 08/2009, a clinic devoted to managing the needs of HCV-positive pts with cancer was started in our center in a collaborative effort between hepatologists and infectious diseases (ID) specialists. HCV-infected pts were initially evaluated by ID. Pts with indications for antiviral treatment were initiated on pegylated interferon alfa 2 (a or b) plus ribavirin following AASLD/IDSA/ACG guidelines. Pts in which therapy was not recommended (e.g. unwillingness to undergo treatment, metastatic cancer, severe anemia, neutropenia, or thrombocytopenia) were followed by hepatologists.

Results:  Sixty-five pts were seen between 8/09 and 5/11 in the clinic. The majority of pts (43 or 66%) had solid tumors, followed by lymphoma (13 or 20%). Fifteen pts (23%) were started on therapy; most of them (13 or 87%) were cancer survivors while 2 had active non-metastatic solid tumors. Frequent visits to monitor for adverse events (AE) were needed, with all patients requiring biweekly visits during the first 3 months of therapy; followed by monthly visits during the rest of the treatment period. The median number of visits was 12 (range 6-13). Among pts who completed therapy, sustained virological response and relapse were observed in 38% and 11% of pts, respectively. Depression requiring psychiatric evaluation and treatment occurred in 50% of treated pts. Hematopoietic growth factors were used in 38% of treated pts due to side-effects of HCV medication (e.g. anemia, neutropenia, or thrombocytopenia). Discontinuation of treatment because of significant AE was observed in 11% of pts. Progression of cancer occurring during therapy or the follow-up period did not occur in any cancer survivor.

Conclusion: Based on our standardized approach, we demonstrate that therapy is possible in this understudied population of HCV-infected pts. Close monitoring with a multidisciplinary approach is required for those started on therapy.


Subject Category: V. Virology including clinical and basic studies of viral infections, including hepatitis

Harrys A. Torres, MD1, Marta Davila, MD2, Victor E. Mulanovich, MD3, Bruno P. Granwehr, MD4, Ethan Miller, MD5, Moises I. Nevah, MD6, Lopa Mishra, MD5, Dimitrios Kontoyiannis, MD, ScD, FACP, FIDSA1 and Issam Raad, MD1, (1)Department of Infectious Diseases, Infection Control and Employee Health. The University of Texas M. D. Anderson Cancer Center, Houston, TX, (2)Gastroenterology, Hepat,& Nutr, University of Texas/MD Anderson Cancer Center, Houston, TX, (3)Infectious Diseases, Infection Control and Employee Health, University of Texas - MD Anderson Cancer Center, Houston, TX, (4)Department of Infectious Diseases, Infection Control and Employee Health. The University of Texas M. D. Anderson Cancer Center , Houston, TX, (5)University of Texas/MD Anderson Cancer Center, Gastroenterology, Hepat,& Nutr, Houston, TX, (6)Gastroenterology, The University of Texas Health Science Center at Houston, Houston, TX

Disclosures:

H. A. Torres, None

M. Davila, None

V. E. Mulanovich, None

B. P. Granwehr, None

E. Miller, None

M. I. Nevah, None

L. Mishra, None

D. Kontoyiannis, None

I. Raad, None

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